Project Summary The majority of persons in the World Trade Center (WTC) occupationally-exposed study cohort followed at the Icahn School of Medicine at Mount Sinai (WTC Health Program, WTCHP) were born during 1945-1965. According to CDC, persons born during this period are at high risk for chronic hepatitis C virus (HCV) infection and are likely to be unaware of their infection. Chronic HCV infection places infected persons at risk for liver cirrhosis, hepatocellular carcinoma, extrahepatic complications, including non-Hodgkin lymphoma. With the development of new therapies that can halt disease progression and provide a virologic cure, CDC has advocated for targeted testing and linkage to care for infected persons in this birth cohort. Provision of HCV testing to the WTCHP cohort at the study site where they are annually assessed will reach the targeted group and may provide epidemiologic data explaining the high risk of HCV infection in this birth cohort. Approximately 20% of patients with chronic HCV infection do not have a known risk factor for HCV infection suggesting that there is more to learn about the epidemiology of the disease. The overarching goals of the proposed research are to determine if the WTCHP cohort is at increased risk of HCV infection, determine if human exposure to human remains, blood, and/or bodily fluids during the WTC recover activities is associated with an increased risk of HCV infection, and to determine if referral to a co-located site for HCV care is associated with improved linkage to HCV care in the members of the WTCHP born during 1945 through 1965.Specifically, the proposed research aims are: (i) to estimate the prevalence of HCV infection in the WTCHP cohort and compare it to the birth cohort in the general population; (ii)To determine if exposure to human remains, blood, and/or bodily fluids during the WTC recovery activities is associated with an increased risk of HCV infection; and (iii) to determine if referral to a co-located site for the treatment of HCV infection is associated with improved linkage to HCV care, compared to referral to other sites, and compared to rates of linkage to care in other studies. Participants who are found to be infected with HCV may choose to be referred to the the Mount Sinai Liver Medicine Practice. The Mount Sinai Liver Medicine Practice is 2 blocks away from the WHTCHP annual assessment site and is a leading treatment center for liver disease which accepts multiple insurance plans and operates on a sliding scale for indigent and Medicaid patients. This project may provide additional epidemiologic data about a life-threatening infection including identification of characteristics associated with increased risk of infection and characteristics associated with successful linkage to care.